From the Guidelines
Retrograde ejaculation is a condition where semen flows backward into the bladder instead of out through the penis during orgasm, and treatment depends on the underlying cause, with medications like pseudoephedrine, imipramine, or chlorpheniramine being potential options to improve the condition by increasing bladder neck muscle tone. This condition occurs when the bladder neck muscle fails to close properly during ejaculation, and common causes include diabetes, multiple sclerosis, spinal cord injuries, prostate or bladder surgery, and certain medications like alpha-blockers, antidepressants, and antipsychotics.
Causes and Risk Factors
- Diabetes
- Multiple sclerosis
- Spinal cord injuries
- Prostate or bladder surgery
- Certain medications like alpha-blockers, antidepressants, and antipsychotics
Treatment Options
- Medications: pseudoephedrine (30-60 mg taken 2-3 hours before sexual activity), imipramine (25-50 mg daily), or chlorpheniramine (4 mg twice daily) to increase bladder neck muscle tone 1
- Lifestyle modifications: maintaining good blood sugar control for diabetics to prevent worsening of the condition
- Sperm retrieval from post-ejaculation urine samples for assisted reproductive techniques for men seeking fertility
- Referral to specialists, such as psychotherapy, sexual/couples counseling, urology, or sexual health specialist, for a multidimensional treatment plan that addresses the underlying issues 1
Important Considerations
- Treatment success varies depending on the cause, with better outcomes when the condition is medication-induced rather than due to surgical damage or neurological disorders
- Retrograde ejaculation can cause infertility and psychological distress, but it is not harmful to health
- Testosterone therapy may relieve symptoms of ED, problems with ejaculation, or problems with orgasm for survivors with hypogonadism, but it should not be used if contraindicated by the primary oncologic diagnosis 1
From the Research
Diagnosis of Retrograde Ejaculation
- Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility 2.
- RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate) 2.
- The diagnosis of RE involves a step-by-step guide to diagnose the condition and the optimal techniques to retrieve sperm 2.
Treatment of Retrograde Ejaculation
- Different therapeutic approaches are present, whether medical or surgical, with limited success rates 3.
- Medical treatment for RE in diabetic patients is a promising method and should be the first line of treatment in these cases 3.
- Imipramine and pseudoephedrine are two drugs that have been used to treat RE, with varying degrees of success 3, 4, 5, 6.
- Imipramine was successful in producing antegrade ejaculate in 38.5% of patients with complete RE, while pseudoephedrine was successful in 47.8% of patients 3.
- A combination of imipramine and pseudoephedrine was successful in 61.5% of patients with complete RE 3.
- Pseudoephedrine treatment has been shown to be effective in improving seminal parameters in men with RE, with some improvement in seminal parameters occurring in 70% of patients 6.
- Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm 2.
Treatment Outcomes
- In cases with partial RE, there was a significant increase in the antegrade semen sample as regards semen volume, sperm count, total, and progressive motility with imipramine alone, pseudoephedrine alone, and both drugs 3.
- Ten patients with retroperitoneal lymph node dissection performed because of testicular cancer, and one with aortic surgery (thromboendarterectomy) were treated with imipramine, and all 11 patients had antegrade ejaculation induced 5.
- Two patients with normal sperm concentrations induced a spontaneous pregnancy under treatment with imipramine 5.